Psychiatry Commons^™

Bayesian Prediction Intervals For Assessing P-Value Variability In Prospective Replication Studies, Olga A. Vsevolozhskaya, Gabriel Ruiz, Dmitri Zaykin

Biostatistics Faculty Publications

Increased availability of data and accessibility of computational tools in recent years have created an unprecedented upsurge of scientific studies driven by statistical analysis. Limitations inherent to statistics impose constraints on the reliability of conclusions drawn from data, so misuse of statistical methods is a growing concern. Hypothesis and significance testing, and the accompanying P-values are being scrutinized as representing the most widely applied and abused practices. One line of critique is that P-values are inherently unfit to fulfill their ostensible role as measures of credibility for scientific hypotheses. It has also been suggested that while P-values …

Improving Detection Of Mental Health Problems In Community Settings In Nepal: Development And Pilot Testing Of The Community Informant Detection Tool, Prasansa Subba, Nagendra P. Luitel, Brandon A. Kohrt, Mark Jordans

Psychiatry and Behavioral Sciences Faculty Publications

Background

Despite increasing efforts to expand availability of mental health services throughout the world, there continues to be limited utilization of these services by persons with mental illness and their families. Community-based detection that facilitates identification and referral of people with mental health problems has been advocated as an effective strategy to increase help-seeking and service utilization. The Community Informant Detection Tool (CIDT) was developed for the community informants to identify people with depression, psychosis, alcohol use problems, epilepsy, and child behavioral problems in community settings. The CIDT has been validated in Nepal and found to be effective in promoting …

A 6-Month Open-Label Extension Study Of Vortioxetine In Pediatric Patients With Depressive Or Anxiety Disorders., Robert L Findling, Adelaide S Robb, Melissa P Delbello, Michael Huss, Nora K Mcnamara, Elias H Sarkis, Russell E Scheffer, Lis H Poulsen, Grace Chen, Ole M Lemming, Philippe Auby

Psychiatry and Behavioral Sciences Faculty Publications

OBJECTIVES: In this 6-month open-label extension (OLE) of NCT01491035 (a 14-day, open-label, pharmacokinetic/safety lead-in study), the long-term safety and tolerability of vortioxetine (5-20 mg/day) were investigated in children and adolescents with a DSM-IV-TR™ diagnosis of depressive or anxiety disorder in the United States or Germany. The study also was designed to provide data to inform dose selection and titration in future pediatric studies with vortioxetine.

METHODS: Safety evaluations included spontaneously reported adverse events (AEs), the Columbia Suicide Severity Rating Scale (C-SSRS), and the Pediatric Adverse Events Rating Scale (PAERS; clinician administered). Clinical effectiveness was determined by Clinical Global Impressions. Comorbid …

The Relationship Between Self-Reported Borderline Personality Features And Prospective Illness Course In Bipolar Disorder., Georg Riemann, Nadine Weisscher, Robert M Post, Lori Altshuler, Susan Mcelroy, Marc A Frye, Paul E Keck, Gabriele S Leverich, Trisha Suppes, Heinz Grunze, Willem A Nolen, Ralph W Kupka

Psychiatry and Behavioral Sciences Faculty Publications

Background

Although bipolar disorder (BD) and borderline personality disorder (BPD) share clinical characteristics and frequently co-occur, their interrelationship is controversial. Especially, the differentiation of rapid cycling BD and BPD can be troublesome. This study investigates the relationship between borderline personality features (BPF) and prospective illness course in patients with BD, and explores the effects of current mood state on self-reported BPF profiles.

Methods

The study included 375 patients who participated in the former Stanley Foundation Bipolar Network. All patients met DSM-IV criteria for bipolar-I disorder (n = 294), bipolar-II disorder (n = 72) or bipolar disorder NOS ( …

Cortical Activation During Action Observation, Action Execution, And Interpersonal Synchrony In Adults: A Functional Near-Infrared Spectroscopy (Fnirs) Study, Anjana Bhat, Michael Hoffman, Susanna Trost, Mckenzie Culotta, Jeffrey Eilbott, Daisuke Tsuzuki, Kevin A. Pelphrey

Psychiatry and Behavioral Sciences Faculty Publications

Introduction: Humans engage in Interpersonal Synchrony (IPS) as they synchronize their own actions with that of a social partner over time. When humans engage in imitation/IPS behaviors, multiple regions in the frontal, temporal, and parietal cortices are activated including the putative Mirror Neuron Systems (Iacoboni, 2005; Buxbaum et al., 2014). In the present study, we compared fNIRS-based cortical activation patterns across three conditions of action observation (“Watch” partner), action execution (“Do” on your own), and IPS (move “Together”).

Methods: Fifteen typically developing adults completed a reach and cleanup task with the right arm while cortical activation was …

Onset Of Multiple Chronic Conditions And Depressive Symptoms: A Life Events Perspective., Maureen Wilson-Genderson, Allison R Heid, Rachel Pruchno

Rowan-Virtua School of Osteopathic Medicine Faculty Scholarship

Background: While the association between depressive symptoms and chronic illness has been the subject of many studies, little is known about whether depressive symptoms differ as a function of the illnesses people have as they transition to living with multiple chronic conditions.

Methods: Self-reports of five diagnosed chronic conditions (arthritis, diabetes, heart disease, hypertension, and pulmonary disease) and depressive symptoms were provided by 3,396 people participating in three waves of the ORANJ BOWL

Results: Between 2006 and 2014, controlling for age, gender, income, race, and a lifetime diagnosis of depression, people who transitioned to having a diagnosis of multiple chronic …

Delirium Reduction Strategies For The Critically Ill, June Chaves, Sam Canonico, Will Cheney, Tammy Corey, Gil Fraser, Alex Kowalewski, Jen Low, Cardiac Intensive Care Unit, Haley Pelletier, Cathy Palleschi, Stephen Tyzik, Suneela Nayak, Ruth Hanselman

Maine Medical Center

Delirium, an acute and fluctuating disturbance of consciousness and cognition, is a common manifestation of acute brain dysfunction in critically ill patients. Patients with delirium have longer hospital stays and a lower 6-month survival rate than do patients without delirium. Preliminary research suggests that delirium may be associated with cognitive impairment that persists months to years after discharge.

In a large acute care hospital, the cardiac intensive care staff became interested in mitigating their unit’s high delirium rate of ventilated patients. At baseline, many members of the healthcare team did not believe that delirium could be prevented and the predominant …

Identification Strategies For The Very High Fall Risk Patient In An Acute Inpatient Psychiatric Unit, P6 Inpatient Geri-Med Psychiatry, Haley Pelletier, Suneela Nayak, Stephen Tyzik, Ruth Hanselman

Maine Medical Center

Patients falling as a result of geriatric and psychiatric impairments are at a much higher risk than the average patient population. An acute care inpatient psychiatric team used baseline metrics to demonstrate increasing fall rates per month that surpassed the unit’s target number. As a result, a quality improvement project around falls was felt to be warranted.

The overall goal of this study was to improve patient safety by reducing falls for their very high risk fall population. A root cause analysis determined that this population was not being properly identified and several tools were developed and employed to better …

Prevention Of Recurrent Affective Episodes Using Extinction Training In The Reconsolidation Window: A Testable Psychotherapeutic Strategy., Robert M Post, Robert Kegan

Psychiatry and Behavioral Sciences Faculty Publications

Stressors may initially precipitate affective episodes, but with sufficient numbers of recurrences, episodes can occur more autonomously. It is postulated the memory engram for these recurrent depressions moves from the conscious representational memory system to the unconscious habit memory system encoded in the striatum. If this were the case, cognitive behavior therapy targeted toward extinction of habit memories could be an effective maneuver for helping reverse the automaticity of affective episode recurrence. Extinction training in the reconsolidation window (which opens about 5 min to 1 h after active memory recall) can revise, reverse, or eliminate the long term memories associated …

Impact Of Cannabis Use On Treatment Outcomes Among Adults Receiving Cognitive-Behavioral Treatment For Ptsd And Substance Use Disorders, Lesia M. Ruglass, Alina Shevorykin, Vanja Radoncic, Kathryn M. Z. Smith, Philip H. Smith, Isaac R. Galatzer-Levy, Santiago Papini, Denise A. Hien

Publications and Research

Background: Research has demonstrated a strong link between trauma, posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) in general and cannabis use disorders in particular. Yet, few studies have examined the impact of cannabis use on treatment outcomes for individuals with co-occurring PTSD and SUDs. Methods: Participants were 136 individuals who received cognitive-behavioral therapies for co-occurring PTSD and SUD. Multivariate regressions were utilized to examine the associations between baseline cannabis use and end-of-treatment outcomes. Multilevel linear growth models were fit to the data to examine the cross-lagged associations between weekly cannabis use and weekly PTSD symptom severity and primary …

Trends In Hospital Admissions Due To Antidepressant-Related Adverse Drug Events From 2001 To 2011 In The U.S., Harish S. Parihar, Hongjun Yin, Jennifer L Gooch, Shari N. Allen, Samuel N. John, Jianwei Xuan

PCOM Scholarly Papers

BACKGROUND: Depression is a prevalent mental health disorder and the fourth leading cause of disability in the world as per the World Health Organization. Use of antidepressants can lead to adverse drug events (ADEs), defined as any injury resulting from medication use. This study aimed to examine changes in hospital admissions due to antidepressant-related ADEs (ArADEs) among different socio-demographic groups and changes in lengths of stay (LOS) and hospital charges in ArADE admissions from 2001 to 2011.

METHODS: The Healthcare Cost and Utilization Project database was used. ArADE admissions in different socio-demographic groups were examined including characteristics such as age, …

Do Pediatric Gastroenterology Doctors Address Pediatric Obesity?, Suruchi Batra, Caitlin Yee, Bernadette Diez, Nicholas Nguyen, Michael J Sheridan, Mark Tufano, Natalie Sikka, Stacie Townsend, Suchitra Hourigan

Psychiatry and Behavioral Sciences Faculty Publications

Objectives:

To assess how often obesity is acknowledged at pediatric gastroenterology outpatient visits.

Methods:

A retrospective chart review was performed to identify obese children seen at a gastroenterology subspecialty clinic over a 1-year period of time; 132 children were identified. Demographics, obesity comorbidities, reasons for referral, diagnosis of obesity, and a plan to address obesity were abstracted. Chi-square or Fisher’s exact tests were used to examine statistical associations.

Results:

Only 49% of children were given a diagnosis of obesity. In total, 52% of children were given a body mass index reduction plan. Those diagnosed with obesity were more likely to …

Translating Mental Health Diagnostic And Symptom Terminology To Train Health Workers And Engage Patients In Cross-Cultural, Non-English Speaking Populations, Bibhav Acharya, Madhur Basnet, Pragya Rimal, David Citrin, Soniya Hirachan, Brandon Kohrt, +Several Additional Authors

Psychiatry and Behavioral Sciences Faculty Publications

Although there are guidelines for transcultural adaptation and validation of psychometric tools, similar resources do not exist for translation of diagnostic and symptom terminology used by health professionals to communicate with one another, their patients, and the public. The issue of translation is particularly salient when working with underserved, non-English speaking populations in high-income countries and low- and middle-income countries. As clinicians, researchers, and educators working in cross-cultural settings, we present four recommendations to avoid common pitfalls in these settings. We demonstrate the need for: (1) harmonization of terminology among clinicians, educators of health professionals, and health policymakers; (2) distinction …

Addressing Culture And Context In Humanitarian Response: Preparing Desk Reviews To Inform Mental Health And Psychosocial Support., M Claire Greene, Mark J D Jordans, Brandon A Kohrt, Peter Ventevogel, Laurence J Kirmayer, Ghayda Hassan, Anna Chiumento, Mark Van Ommeren, Wietse A Tol

Psychiatry and Behavioral Sciences Faculty Publications

Delivery of effective mental health and psychosocial support programs requires knowledge of existing health systems and socio-cultural context. To respond rapidly to humanitarian emergencies, international organizations often seek to design programs according to international guidelines and mobilize external human resources to manage and deliver programs. Familiarizing international humanitarian practitioners with local culture and contextualizing programs is essential to minimize risk of harm, maximize benefit, and optimize efficient use of resources. Timely literature reviews on traditional health practices, cultural beliefs and attitudes toward mental health and illness, local health care systems and previous experiences with humanitarian interventions can provide international practitioners …

Elucidating Adolescent Aspirational Models For The Design Of Public Mental Health Interventions: A Mixed-Method Study In Rural Nepal, Sauharda Rai, Safar Bikram Adhikari, Nanda Raj Acharya, Bonnie N. Kaiser, Brandon A. Kohrt

Psychiatry and Behavioral Sciences Faculty Publications

Background

Adolescent aspirational models are sets of preferences for an idealized self. Aspirational models influence behavior and exposure to risk factors that shape adult mental and physical health. Cross-cultural understandings of adolescent aspirational models are crucial for successful global mental health programs. The study objective was elucidating adolescent aspirational models to inform interventions in Nepal.

Methods

Twenty qualitative life trajectory interviews were conducted among adolescents, teachers, and parents. Card sorting (rating and ranking activities) were administered to 72 adolescents aged 15–19 years, stratified by caste/ethnicity: upper caste Brahman and Chhetri, occupational caste Dalit, and ethnic minority Janajati. …

Situational Analysis To Inform Development Of Primary Care And Community-Based Mental Health Services For Severe Mental Disorders In Nepal, Mangesh Angdembe, Brandon A. Kohrt, Mark Jordans, Damodar Rimal, Nagendra Luitel

Psychiatry and Behavioral Sciences Faculty Publications

Background

Nepal is representative of Low and Middle Income Countries (LMIC) with limited availability of mental health services in rural areas, in which the majority of the population resides.

Methods

This formative qualitative study explores resources, challenges, and potential barriers to the development and implementation of evidence-based Comprehensive Community-based Mental Health Services (CCMHS) in accordance with the mental health Gap Action Programme (mhGAP) for persons with severe mental health disorders and epilepsy. Focus Group Discussions (FGDs, n = 9) and Key-Informant Interviews (KIIs, n = 26) were conducted in a rural district in western Nepal. Qualitative data were coded using …

Evaluation Of Outcomes For Psychosis And Epilepsy Treatment Delivered By Primary Health Care Workers In Nepal: A Cohort Study., M J D Jordans, L Aldridge, N P Luitel, F Baingana, B A Kohrt

Psychiatry and Behavioral Sciences Faculty Publications

Background: Most evaluations of task-shifting have focused on common mental disorders. Much less work has been done on severe mental neurological and substance use (MNS) disorders, such as chronic psychosis and epilepsy. Given the high burden associated with severe MNS and the lack of mental health professionals in low and middle income countries, evaluations on the impact of task-shifting for these disorders are important.

Methods: In a rural district of Nepal, a community mental health program, based on World Health Organization's Mental Health Gap Action Programme guidelines, was evaluated using a cohort study design. People with epilepsy and psychotic disorders …

Addressing Culture And Context In Humanitarian Response: Preparing Desk Reviews To Inform Mental Health And Psychosocial Support., M Claire Greene, Mark J D Jordans, Brandon A Kohrt, Peter Ventevogel, Laurence J Kirmayer, Ghayda Hassan, Anna Chiumento, Mark Van Ommeren, Wietse A Tol

Psychiatry and Behavioral Sciences Faculty Publications

Delivery of effective mental health and psychosocial support programs requires knowledge of existing health systems and socio-cultural context. To respond rapidly to humanitarian emergencies, international organizations often seek to design programs according to international guidelines and mobilize external human resources to manage and deliver programs. Familiarizing international humanitarian practitioners with local culture and contextualizing programs is essential to minimize risk of harm, maximize benefit, and optimize efficient use of resources. Timely literature reviews on traditional health practices, cultural beliefs and attitudes toward mental health and illness, local health care systems and previous experiences with humanitarian interventions can provide international practitioners …

Can Creating A Behavioral Task Force On The Medical And Surgical Floor Increase Staff Satisfaction Rates?, Amy Lee

Interprofessional Research and Innovations Council

Can creating a Behavioral Task Force on the medical and surgical floor increase staff satisfaction rates?

Amy Lee, RN

Abstract

Background. The medical and surgical units within Maine Medical Center have seen an influx of patients with behavioral disturbances. Staff voice concerns regarding lack of knowledge and lack of support while treating patients with a medical condition and dual diagnosis of a psychiatric disorder with behavioral disturbances.

Purpose (PICOT). In adult patients on R5 with behavioral disturbances, how does the implementation of a Behavioral Task Force compared to the current practice affect staff knowledge and satisfaction?

Method. This quality improvement …